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Investment in hospital nurses leads to better patient outcomes and pays for itself financially through improved care, according to a study by US nursing academics.
It found patients admitted to hospitals with good nurse staffing and work environments were less likely to die or be readmitted, and had shorter lengths of stay, compared with patients in hospitals with worse nursing resources.
“Patients in each of the medical condition categories in our study experienced a benefit from superior nursing resources”
These benefits to patients were gained with almost no difference in costs, even when accounting for the higher investment in nursing, according to researchers at the University of Pennsylvania School of Nursing, including world-renowned nurse academic Dr Linda Aiken.
The study involved 74,045 matched pairs of patients from across 306 acute care hospitals in the states of California, Florida, New Jersey and Pennsylvania.
Patients were admitted for common conditions including sepsis, congestive heart failure, pneumonia, stroke and acute myocardial infarction.
The hospitals were split into a “better” or “worse” group depending on their patient-to-nurse ratios, skill mix, proportions of degree-level nurses, and nurse work environments.
The researchers found that, among all patients, the odds of mortality or readmission within 30 days were each 7% lower in the better nursing resourced hospitals compared with matched patients in the worse resourced hospitals.
While the likelihood of admission to intensive care was 6% higher in hospitals in the “better” group than the “worse” group, overall average length of stay was shorter, at 5.38 days in well-resourced sites versus 5.66 days in the others.
The average cost per patient was lower in the “better” hospitals at $18,436, compared with $18,708 at the “worse” hospitals, according to the study published last week in the Journal of General Internal Medicine.
The figure was calculated by looking at the cost of resources used for the patient during the hospital admission as well as any costs accrued 30 days post-admission.
When adjusting for any additional spending on nursing resources, the differences in costs were “insignificant” at $18,848 (£14,460) per patient in the hospitals in the “better” group and $18,671 (£14,324) in those in the “worse” group.
The greatest differences in clinical outcomes and costs were found among patients admitted for sepsis.
There was a “significantly lower” likelihood of both death and readmission within 30 days in the “better” nursing hospitals compared with the “worse” ones and the nurse-adjusted costs were are also “significantly lower” at $23,238 (£17,831) versus $23,680 (£18,169).
“Our finding that sepsis outcomes and costs of care were superior in hospitals with better nursing resources suggests that attention to system-level attributes of nursing is important to improving sepsis outcomes,” said the authors.
However, they added: “Whether through lower mortality, fewer readmissions, or shorter lengths of stay, patients in each of the medical condition categories in our study experienced a benefit from superior nursing resources.”
Overall, the researchers concluded that investments in nursing resources were associated with “better clinical outcomes and almost no difference in cost”.
They added that their findings “inform the economic case for hospital nursing”.